ACL Rehab (Phases and Exercises Explained)

ACL rehab

Are you preparing for ACL surgery and rehab? We understand that any operation – and the lengthy recovery that follows – can be daunting.

In this blog we aim to shed some light on each phase of ACL rehab, including the goals for every stage, along with typical exercises carried out.

If you’re looking for a trusted Brisbane physiotherapist to assist with your rehab, you can make a booking with our clinicians here.

ACL Rehab Timeline

The timeframe for ACL rehab following surgery for a grade three ACL injury generally ranges from 9-18 months for return to sport. This timeline will be dependent on the individual and their adherence to their rehab program. For example, a professional athlete with a strong focus on rehabilitation and daily access to health professionals and equipment can return to sport in as little as 9 months. For most people, however, they are not back on the field until around 12 months post-op or more.

Grade one to two tears (stretch or partial tear of the ACL) are less frequent. These lower grade tears are less severe than a grade three injury and can take roughly 3-6 months to rehabilitate.

There is also non-operative rehabilitation and management of ACL injuries emerging, however, as this is less common we will focus on the operative management for this blog.

ACL Rehab Phases

  • Pre-operative
  • Phase 1: Recovery from surgery
  • Phase 2: Strength and neuromuscular control
  • Phase 3: Running, agility and landing
  • Phase 4: Return to sport
  • Phase 5: Prevent re-injury

Pre-Op ACL Surgery

The aims of this phase include:

  • Eliminate swelling,
  • Recover full range of motion, and
  • Regain strength in the hamstring and quads. (The goal is to achieve strength of 90% or more compared with the other side.)

Exercises during this phase focus on mobility to gain as much knee bend and extension, in addition to strength exercises with a focus on the quads (this can include weighted exercises, jump/land exercises dependent on the condition of the knee) and aerobic exercise such as cycling.

It’s important to avoid aggressive change of direction activities during this phase.

Phase 1 ACL Rehab: Recovery from Surgery

After surgery the goals of Phase 1 are:

  • Regain ability to straighten knee (full extension),
  • Reduce swelling, and
  • Get the quadriceps firing again.

To manage swelling ice will be regularly applied to the area as well as compression bandages/ stockings.

Exercises during this phase typically include basic quadriceps setting exercises, as well as gentle range of motion exercises to improve knee bend and extension.

Phase 2 ACL Rehab: Strength and Neuromuscular control

During this phase the main goals are:

  • Regain most of your single leg balance,
  • Recover the majority your muscle strength, and
  • Ability to carry out single-leg squat with good alignment and technique.

Common exercises included during this phase of the rehabilitation are calf raises, hip abduction strengthening, gait re-education drills, squats, step-ups, and lunges. Low impact, non-aerobic activity like swimming, walking, and cycling is also typically included in this phase.

Where possible exercises are single leg focussed to minimise compensation.

Phase 3 ACL Rehab: Running, Agility and Landing

The goals of Phase 3 are:

  • Achieve excellent hopping performance (technique, distances, & endurance),
  • Complete an agility program and modified game play successfully, and
  • Return to full strength and balance.

Agility drills such as hopping, jumping, shuttle runs, and ladder drills are common exercise inclusions in phase 3.

Phase 4 ACL Rehab: Return to Sport

The return to sport phase is different for every individual. At this point in recovery, it’s vital that the knee is stable and strong AND that the athlete is confident and mentally prepared to step back on the field.

This phase should include training activities that were part of the athlete’s normal routine or performed regularly prior to injury.

For a successful return to sport, there will be a focus on repeating successful training and match play situations during rehabilitation.

The main emphasis is on progressive training during this phase, but it will also consist of balance, agility, strength, and landing work.

Phase 5 ACL Rehab: Prevent Re-injury

To avoid re-injury an injury prevention program should be continued.

The program should be performed prior to every training session and game. This should include strength, balance, and plyometric (jumping) exercises.

Would you like more information on these rehabilitation phases? Head to the Melbourne ACL Rehabilitation Guide 2.0.

What should be avoided during ACL Rehab?

Do not rush the rehab process!

At some later stages, even as early as phase 3, it can be tempting to go back to sport early – however this often leads to re-injury.

It’s important to listen to advice from your qualified medical professional and physiotherapists.

Read our blog here to learn more about ACL injury treatment and how physio can help. Or schedule an appointment with our clinicians in Samford, Ashgrove, and Moorooka today.